spenac Posted July 4, 2007 Share Posted July 4, 2007 I will not discuss your scenario further. :!: I am glad surgery went well. Link to comment Share on other sites More sharing options...
katbemeEMT-B Posted July 5, 2007 Share Posted July 5, 2007 First off Broken, I am glad your surgery went well. As far as this scenario, the fire monkeys did NOT do their job. The first thing they should have done after checking airway, breathing, and circulation was to apply a c-collar regardless of whether you were lying on the ground, sitting up, or standing up. The next thing that should have been done was to stabilize the fracture with a traction splint. If no traction splint was available to them then splint while applying manual traction. Then they should have placed you on a LBB while padding the leg with towels, clothing, and whatever else they could find. This is where your further injury probably took place. It is also why it was so painful. As for the EMTs, if they truly treated you that abusively, then I guess I would get statements from fire monkeys and file a complaint with your EMS state licensing association. As far as their actual care for you, I read the protocols regarding patient rights. Was the other hospitals within their PSA? If not, then no they can not transport you there without approval from MC. If it was, then yes you had the right to be taken where you want. Also, I find it hard to believe that there wasn't a single pair of shears on that ambulance. I would also think one of the firemonkeys would have had a pair. I also did not find it anywhere in state protocols that they are required. Also, per Alabama protocol, treatment of a femur fracture includes: large bore IV for femur fracture so they can admin. normal saline, meds, and antibiotics Stabilize fracture Consider total spinal immobilization (LBB) Examine for other injuries (this would include rolling you so they could inspect the other side) Administer pain med via IV access (only if these were paramedics. EMT-basics and Intermediates can not administer drugs). Monitor vitals and for shock transport as necessary (no life threatening injury, no little red lights and sirens) That translates to a stable patient gets speed limit ride and stops at all stop signs and red lights. The unstable patient gets the ride of their life. I do find it hard to believe that any EMT or medic would have purposely went slow just to spend time with you (not a personal attack). They were maybe considering the fact that you were in pain and going slower to decrease the jolt of the bumpy road on your injury. As far as your care at the hospital, sorry to say but NO doctor can keep a competent patient in their hospital for any reason. Even if they are dying they have the right to leave as soon as they walk in the door. Keeping them there falls under the law of holding some one against their will which is equivalent to kidnapping. So if you stated you wanted to leave they have no choice but to sign you AMA. They also have a responsibility to control your pain effectively and in a timely fashion unless there is cause to be concerned that the pain medication will further harm your well-being (ie: ETOH, drugs, altered mental status, etc.). So if this was a closed fracture why did you state there was a gaping wound. Where was this wound? Anyway, just my two cents. Oh and BTW, I have been on the receiving side of EMS care. I did not agree with what the medics were doing and politely and reasonably and they respected that. Maybe your attitude had something to do with it. If you were as angry and screaming then as you are now I can don't doubt that they treated you with little or no respect. You see, kindness goes a long way. Link to comment Share on other sites More sharing options...
spenac Posted July 5, 2007 Share Posted July 5, 2007 khanek also remember a argumentative, aggravated acting patient is a classic sign of head trauma, so everything said is from a person not legally able to make decisions. So then as a crew you do what you deem is best for the patient under implied consent. Link to comment Share on other sites More sharing options...
katbemeEMT-B Posted July 5, 2007 Share Posted July 5, 2007 khanek also remember a argumentative, aggravated acting patient is a classic sign of head trauma, so everything said is from a person not legally able to make decisions. So then as a crew you do what you deem is best for the patient under implied consent. This is very true. Maybe the fact that he is still argumentative proves he had a head injury. Link to comment Share on other sites More sharing options...
spenac Posted July 5, 2007 Share Posted July 5, 2007 Maybe the fact that he is still argumentative proves he had a head injury. rofl But again as before I'm glad surgery went well. Link to comment Share on other sites More sharing options...
whit72 Posted July 5, 2007 Share Posted July 5, 2007 The only thing I would disagree with is, that a femur fx can be considered to be non-life threatning in the field. Without diagnostic testing the inclusion of great vessels can not be ruled out. If that pt does begin to spiral out of control, due internal blood loss while you are in-transit, there is not going to be much you will be able to do to stop that process, or anyboby else for that matter except a surgeon I treat all femur fx's as life threatning injuries until proven otherwise. In the ER. I have seen them stable on scene and en-route to the hospital their pressure ends up in the toilet. Unless your hanging blood in your area. As a trauma surgeon from the south once said to me "Aint much you gonna do for lacerated femoral artery in the back of that ambulance" Link to comment Share on other sites More sharing options...
katbemeEMT-B Posted July 5, 2007 Share Posted July 5, 2007 I do agree Whit that a femur fx can be life-threatening. That it also why it is so important to watch the patient for any signs of shock. But it also doesn't warrant lights and sirens and high speeds unless they would show signs of decomposition. Continual reassessment of the patient would allow you to determine if you need to upgrade transport. In reference to this patient, if his description is true, he was not suffering from any signs of shock as he stated all vitals were normal even after arriving at the ED. I guess that does surprise me as I have seen many patients with tib/fib, pelvic, and radial fx show signs of shock within 15 minutes of onset of injury. But I guess I wasn't there so who knows. Link to comment Share on other sites More sharing options...
Dustdevil Posted July 5, 2007 Share Posted July 5, 2007 This is very true. Maybe the fact that he is still argumentative proves he had a head injury. LMFAO!! That's beauty! Link to comment Share on other sites More sharing options...
ERDoc Posted July 5, 2007 Share Posted July 5, 2007 But it also doesn't warrant lights and sirens and high speeds unless they would show signs of decomposition. If your pt is showing signs of decomposition, I don't think lights and sirens are going to help much. I think you may also have more problems than the femur fx. Link to comment Share on other sites More sharing options...
spenac Posted July 5, 2007 Share Posted July 5, 2007 If your pt is showing signs of decomposition, I don't think lights and sirens are going to help much. I think you may also have more problems than the femur fx. Good catch doc. How did I miss that? Link to comment Share on other sites More sharing options...
Recommended Posts